HIV/AIDs, Public Health, and Prisons in the Late-Twentieth Century

AIDS and Prisons

AIDS first appeared in Europe in the early 1980s, and prisons were soon identified as sites that would face particular challenges. Injecting drug use was one of the primary modes of HIV transmission, and the large numbers of drug users in prisons meant that HIV prevalence was high.[1] Added to this were suspicions about the frequency of sexual activity and injecting drug use within prisons, and concerns about overcrowding and unsanitary conditions. Prisoners were not only relatively likely to arrive in prison with HIV or AIDS, but prisons themselves were thought to encourage the spread of infection amongst inmates and from inmates to staff.

Response of Prison Medical Services

In both England and Ireland, the need for prison services to take action became apparent in 1985 as the first tests for HIV were conducted and the first positive results were returned. Widespread ignorance and fear about AIDS was exacerbated within the closed environment of the prison, where mistrust and rumour prevailed, and the immediate reaction was one of panic. In Dublin, the first inmate testing positive for HIV was immediately released from Mountjoy prison. In Chelmsford, the death from an AIDS-related illness of the prison chaplain saw the local Prison Officers’ Association taking control of all movement in and out of the prison, accompanied by lurid headlines and widely publicised concerns over contagion via the holy communion cup used during religious services. Urgent decisions had to be made about how to prevent much-feared outbreaks of illness, and how to minimise disruptions of this kind to prison regimes.

Segregation

Many branches of prison officer unions called for prisoners with HIV or AIDS to be segregated in separate units or landings, and for staff to be made aware of their diagnosis. In the face of pressure of this kind, including staff protests, and an unexpectedly large number of diagnoses amongst prisoners in Mountjoy, Ireland’s Department of Justice determined that prisoners with HIV or AIDS would be held separately from the general prison population. Critics argued that this stigmatisation and the associated lack of medical confidentiality was a disincentive for prisoners to request an HIV test or to reveal a pre-existing diagnosis, which presented grave risks to individual and public health. Supporters of segregation maintained that it was necessary to prevent the spread of infection, and for the provision of services and facilities that this particular group of prisoners needed.

Viral Infectivity Regulations

In England, a more flexible policy allowed individual prisons to implement Viral Infectivity Regulations in cases of HIV if they so chose: this could involve housing prisoners separately from the general population and restricting their work or sports activities, but it was at the discretion of medical officers and governors. Some prisons, such as Wandsworth in London, created separate wings for HIV+ prisoners, while others like Bristol did not introduce any form of special treatment. Wherever a policy of separating prisoners with HIV or AIDS was introduced, it proved extremely difficult to dismantle.

Prison Condoms

As charities, health authorities, and gay community groups worked to spread information about safer sex, there were calls at national and international levels for prisons to play their part and to provide condoms to inmates.[2] Refusals in the 1980s on the part of the prison service of England and Wales saw protests outside prisons, questions raised in Parliament, and considerable internal debate. Eventually, the prison service developed a compromise whereby prison doctors could provide condoms if, in their view, there was a valid medical need. In Ireland, where homosexuality remained illegal until 1993 and condoms were less easily available outside as well as inside prisons, the subject was not raised until the prison medical service was redeveloped in the early 2000s.

Drug Addiction

More significant in Ireland, where all inmates in the HIV separation unit had a history of heroin use, was the issue of drug addiction. Drug services in the community had changed rapidly in response to HIV, and the prison service seemed to lag behind. Community innovations to help prevent the spread of HIV included needle exchanges, methadone prescribing on a long-term basis as a heroin substitute, and outreach services to provide drug users with information about safer injecting, but these were resisted within prisons. Addiction services in England were also criticised, and in the 2000s the Home Office had to pay compensation to large numbers of prisoners who had been denied adequate treatment for drug addiction throughout the 1990s.[3]

Conclusions

The emergence of HIV and AIDS highlighted many of the existing tensions and problems surrounding healthcare for prisoners. It exposed the limitations of existing medical services and health promotion activities, and the emphasis upon control and punishment rather than care and rehabilitation. Some changes were introduced; their nature and extent were affected by existing policies and structures, the views of prison staff, pressure from national and international bodies concerned with prisons and public health, and broader attitudes towards both HIV/AIDS and crime and punishment. Despite statements in support of providing the same standard of medical care within prisons as elsewhere in the community, and pressure on prisons to play their part in preventing the spread of HIV, these goals were evidently difficult to achieve.

[2] For example: Council of Europe, Parliamentary Assembly, ‘Recommendation 1080 on a Coordinated European Policy to Prevent the Spread of AIDS in Prisons’, (1988), available at: <https://www1.umn.edu/humanrts/instree/recommendation1080.html&gt; [Last accessed: 8 April 2016]; Advisory Council on the Misuse of Drugs, AIDS and Drug Misuse: Part One (London, 1988).